Polyomavirus polymerase chain reaction as a surrogate marker of polyomavirus-associated nephropathy

Helen B. Viscount, Albert J. Eid, Mark J. Espy, Matthew D. Griffin, Kristine M. Thomsen, William S. Harmsen, Raymund R Razonable, Thomas F. Smith

Research output: Contribution to journalArticle

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Abstract

BACKGROUND. Polyomavirus-associated nephropathy (PVAN) is a significant cause of allograft loss after renal transplantation. A noninvasive assay that can guide the evaluation of PVAN would be of clinical value. We compared the utility of BK virus (BKV) polymerase chain reaction (PCR) and urine cytology in screening for concurrent PVAN. METHODS. We used PCR to test urine and plasma samples from renal recipients simultaneously for BKV DNA. Additionally, we tested urine samples for decoy cells. Sample results were correlated with biopsy-proven PVAN. Receiver-operator characteristic curves were used to determine viral load thresholds associated with concurrent PVAN. RESULTS. In this cross-sectional study, BKV viruria, viremia, and urinary decoy cells were detected in 24%, 9%, and 13% of renal recipients, respectively. Among 114 patients who had renal allograft biopsy, four (3.5%) were diagnosed with PVAN. Using pathology as gold standard for the diagnosis of PVAN, BKV viremia threshold of >1.6E+04 copies/mL had 100% sensitivity, 96% specificity, 50% positive predictive value, and 100% negative predictive value. A BKV viruria threshold of >2.5E+07 copies/mL had 100% sensitivity, 92% specificity, 31% positive predictive value, and 100% negative predictive value. In contrast, urine decoy cells had 25% sensitivity, 84% specificity, 5% positive predictive value, and 97% negative predictive value for the diagnosis of concurrent PVAN. CONCLUSION. BKV PCR may be a clinically useful noninvasive test to identify renal recipients with concurrent PVAN. BKV DNA >1.6E+04 copies/mL of plasma and >2.5E+07 copies/mL of urine were highly associated with concurrent PVAN whereas a negative PCR test makes the diagnosis of PVAN highly unlikely.

Original languageEnglish (US)
Pages (from-to)340-345
Number of pages6
JournalTransplantation
Volume84
Issue number3
DOIs
StatePublished - Aug 2007

Fingerprint

Polyomavirus
BK Virus
Biomarkers
Polymerase Chain Reaction
Urine
Kidney
Viremia
Sensitivity and Specificity
Allografts
Biopsy
DNA
Viral Load
Kidney Transplantation
Cell Biology
Cross-Sectional Studies
Pathology

Keywords

  • BKV
  • Decoy cells
  • Glomerular filtration rate
  • Quantitative PCR
  • Real-time PCR
  • Renal transplantation
  • Urine cytology

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Viscount, H. B., Eid, A. J., Espy, M. J., Griffin, M. D., Thomsen, K. M., Harmsen, W. S., ... Smith, T. F. (2007). Polyomavirus polymerase chain reaction as a surrogate marker of polyomavirus-associated nephropathy. Transplantation, 84(3), 340-345. https://doi.org/10.1097/01.tp.0000275205.41078.51

Polyomavirus polymerase chain reaction as a surrogate marker of polyomavirus-associated nephropathy. / Viscount, Helen B.; Eid, Albert J.; Espy, Mark J.; Griffin, Matthew D.; Thomsen, Kristine M.; Harmsen, William S.; Razonable, Raymund R; Smith, Thomas F.

In: Transplantation, Vol. 84, No. 3, 08.2007, p. 340-345.

Research output: Contribution to journalArticle

Viscount, HB, Eid, AJ, Espy, MJ, Griffin, MD, Thomsen, KM, Harmsen, WS, Razonable, RR & Smith, TF 2007, 'Polyomavirus polymerase chain reaction as a surrogate marker of polyomavirus-associated nephropathy', Transplantation, vol. 84, no. 3, pp. 340-345. https://doi.org/10.1097/01.tp.0000275205.41078.51
Viscount, Helen B. ; Eid, Albert J. ; Espy, Mark J. ; Griffin, Matthew D. ; Thomsen, Kristine M. ; Harmsen, William S. ; Razonable, Raymund R ; Smith, Thomas F. / Polyomavirus polymerase chain reaction as a surrogate marker of polyomavirus-associated nephropathy. In: Transplantation. 2007 ; Vol. 84, No. 3. pp. 340-345.
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abstract = "BACKGROUND. Polyomavirus-associated nephropathy (PVAN) is a significant cause of allograft loss after renal transplantation. A noninvasive assay that can guide the evaluation of PVAN would be of clinical value. We compared the utility of BK virus (BKV) polymerase chain reaction (PCR) and urine cytology in screening for concurrent PVAN. METHODS. We used PCR to test urine and plasma samples from renal recipients simultaneously for BKV DNA. Additionally, we tested urine samples for decoy cells. Sample results were correlated with biopsy-proven PVAN. Receiver-operator characteristic curves were used to determine viral load thresholds associated with concurrent PVAN. RESULTS. In this cross-sectional study, BKV viruria, viremia, and urinary decoy cells were detected in 24{\%}, 9{\%}, and 13{\%} of renal recipients, respectively. Among 114 patients who had renal allograft biopsy, four (3.5{\%}) were diagnosed with PVAN. Using pathology as gold standard for the diagnosis of PVAN, BKV viremia threshold of >1.6E+04 copies/mL had 100{\%} sensitivity, 96{\%} specificity, 50{\%} positive predictive value, and 100{\%} negative predictive value. A BKV viruria threshold of >2.5E+07 copies/mL had 100{\%} sensitivity, 92{\%} specificity, 31{\%} positive predictive value, and 100{\%} negative predictive value. In contrast, urine decoy cells had 25{\%} sensitivity, 84{\%} specificity, 5{\%} positive predictive value, and 97{\%} negative predictive value for the diagnosis of concurrent PVAN. CONCLUSION. BKV PCR may be a clinically useful noninvasive test to identify renal recipients with concurrent PVAN. BKV DNA >1.6E+04 copies/mL of plasma and >2.5E+07 copies/mL of urine were highly associated with concurrent PVAN whereas a negative PCR test makes the diagnosis of PVAN highly unlikely.",
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AU - Eid, Albert J.

AU - Espy, Mark J.

AU - Griffin, Matthew D.

AU - Thomsen, Kristine M.

AU - Harmsen, William S.

AU - Razonable, Raymund R

AU - Smith, Thomas F.

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N2 - BACKGROUND. Polyomavirus-associated nephropathy (PVAN) is a significant cause of allograft loss after renal transplantation. A noninvasive assay that can guide the evaluation of PVAN would be of clinical value. We compared the utility of BK virus (BKV) polymerase chain reaction (PCR) and urine cytology in screening for concurrent PVAN. METHODS. We used PCR to test urine and plasma samples from renal recipients simultaneously for BKV DNA. Additionally, we tested urine samples for decoy cells. Sample results were correlated with biopsy-proven PVAN. Receiver-operator characteristic curves were used to determine viral load thresholds associated with concurrent PVAN. RESULTS. In this cross-sectional study, BKV viruria, viremia, and urinary decoy cells were detected in 24%, 9%, and 13% of renal recipients, respectively. Among 114 patients who had renal allograft biopsy, four (3.5%) were diagnosed with PVAN. Using pathology as gold standard for the diagnosis of PVAN, BKV viremia threshold of >1.6E+04 copies/mL had 100% sensitivity, 96% specificity, 50% positive predictive value, and 100% negative predictive value. A BKV viruria threshold of >2.5E+07 copies/mL had 100% sensitivity, 92% specificity, 31% positive predictive value, and 100% negative predictive value. In contrast, urine decoy cells had 25% sensitivity, 84% specificity, 5% positive predictive value, and 97% negative predictive value for the diagnosis of concurrent PVAN. CONCLUSION. BKV PCR may be a clinically useful noninvasive test to identify renal recipients with concurrent PVAN. BKV DNA >1.6E+04 copies/mL of plasma and >2.5E+07 copies/mL of urine were highly associated with concurrent PVAN whereas a negative PCR test makes the diagnosis of PVAN highly unlikely.

AB - BACKGROUND. Polyomavirus-associated nephropathy (PVAN) is a significant cause of allograft loss after renal transplantation. A noninvasive assay that can guide the evaluation of PVAN would be of clinical value. We compared the utility of BK virus (BKV) polymerase chain reaction (PCR) and urine cytology in screening for concurrent PVAN. METHODS. We used PCR to test urine and plasma samples from renal recipients simultaneously for BKV DNA. Additionally, we tested urine samples for decoy cells. Sample results were correlated with biopsy-proven PVAN. Receiver-operator characteristic curves were used to determine viral load thresholds associated with concurrent PVAN. RESULTS. In this cross-sectional study, BKV viruria, viremia, and urinary decoy cells were detected in 24%, 9%, and 13% of renal recipients, respectively. Among 114 patients who had renal allograft biopsy, four (3.5%) were diagnosed with PVAN. Using pathology as gold standard for the diagnosis of PVAN, BKV viremia threshold of >1.6E+04 copies/mL had 100% sensitivity, 96% specificity, 50% positive predictive value, and 100% negative predictive value. A BKV viruria threshold of >2.5E+07 copies/mL had 100% sensitivity, 92% specificity, 31% positive predictive value, and 100% negative predictive value. In contrast, urine decoy cells had 25% sensitivity, 84% specificity, 5% positive predictive value, and 97% negative predictive value for the diagnosis of concurrent PVAN. CONCLUSION. BKV PCR may be a clinically useful noninvasive test to identify renal recipients with concurrent PVAN. BKV DNA >1.6E+04 copies/mL of plasma and >2.5E+07 copies/mL of urine were highly associated with concurrent PVAN whereas a negative PCR test makes the diagnosis of PVAN highly unlikely.

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KW - Glomerular filtration rate

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KW - Real-time PCR

KW - Renal transplantation

KW - Urine cytology

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